Applicant (First, Last, Middle):
1. KEY PERSONNEL
Starting with the PI, list personnel in alphabetical order, last name first.
Name
Name
Name
Name
Institution
Institution
Institution
Institution
Role on Project
PI
Role on Project
Role on Project
Role on Project
2. OBJECTIVE AND DESCRIPTION OF TARGET
In 1-2 sentences please describe the overall objective and briefly describe the proposed target.
Overall objective
Brief description of target
Page 1 of 5

Applicant (First, Last, Middle):
3. DESCRIPTION OF PROJECT
1) Rationale and Significance: Please briefly describe the proposed target or strategy including existing validation for the target – highlighting validation in human tissues.
2) Therapeutic and Discovery Approach: Please complete the table below
Therapeutic Approach
TARGET
What target, pathway, or cellular phenotype would you like to modulate?
VALIDATION
What biological findings support modulation of this target, pathway, or cellular phenotype in T1D therapy?
THERAPEUTIC PARADIGM
How do you imagine these modulators being used as
T1D therapeutics?
CATEGORY
Choose one that best fits your proposal
List the target, pathway, or cellular phenotype
(e.g. “GLP1R” or “the NFkB pathway” or “oxidative stress”)
Provide a brief description of published work with appropriate reference(s). If appropriate, organize key supplemental data into one attached page.
Describe in simple terms the ideal profile of a therapeutic discovered from the proposed work. Address the following questions:
Would it be applicable to patients with long-standing T1D, new-onset or at-risk patients?
Would it be used in concert with insulin or as a stand-alone therapy?
Would the drug be given chronically to manage the disease symptoms or for a short period of time to reverse or “cure” the disease?
What issues could arise from modulating this target, pathway, or phenotype outside of the intended purpose? (i.e. known or predicted side effects)
Speculation is encouraged.


Reducing beta cell stress and improving beta cell survival and function

Promoting beta cell replication and regulation of beta cell mass
Reprogramming of non-beta cells (e.g. alpha cells) towards a beta cell phenotype

Dedifferentiating/redifferentiating beta cells

Or other categories to be described
Discovery Approach
BIOLOGICAL ASSAY
What methods are available to assess modulation of this target, pathway, or cellular phenotype?
REFERENCES & CONTROLS
Are reference or control modulators available?
List methods of which you are aware and comment on their appropriateness. These need not be applicable to high-throughput screening. Note whether these methods are used in your laboratory and if you possess specialized reagents that enable them (e.g., a reporter gene).
Provide literature references only for methods not used in your laboratory.
List any compounds, proteins, peptides, antibodies, RNAi reagents, or mutant cell types that may serve as reference or control conditions for the proposed studies and briefly explain their relevance (list all that are applicable)
Page 2 of 5

Applicant (First, Last, Middle):
PREVIOUS DISCOVERY
WORK
Have you or others engaged in high-throughput screening for this target, pathway, or cellular phenotype?
Describe previous screening efforts closely related to the proposed work, whether carried out by you or others. Include failed attempts to initiate screening (e.g., lack of suitable assay development, inability to execute agreements or material transfers with the collaborating institute).
Page 3 of 5

Applicant (First, Last, Middle):
OTHER SUPPORT
Is support for this project being provided or sought
elsewhere?
Yes No
If yes, list the funding agency, the title of the project, year one and total funding received/requested.
Provide aims/abstract if available. Specify areas where synergy exists and additional resources could be leveraged to drive the project.
Page 4 of 5

Applicant (First, Last, Middle):
BIOGRAPHICAL SKETCH
Follow this format, or use the NIH biosketch format, for each person.
Duplicate biosketch form as needed. DO NOT EXCEED 2 PAGES per person.
NAME POSITION TITLE
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
INSTITUTION AND LOCATION DEGREE YEAR(s) FIELD OF STUDY
A.
Positions and Honors. List in chronological order previous positions, concluding with your present position.
List any honors. Include present membership on any public or private advisory committee.
B.
Selected peer-reviewed publications (in chronological order). List the title and complete reference to all publications during the past three years and to representative earlier publications pertinent to this application.
Do not include publications submitted or in preparation. (Do not exceed this page plus one continuation page.)
Page 5 of 5